Abstract
BackgroundHypertension, a major risk factor of cardiovascular mortality, is a critical issue for public health. Although Baduanjin (Eight Brocades, EB), a traditional Chinese exercise, might influence blood pressure, glucose, and lipid status, the magnitude of true effects and subgroup differences remains unclear. Therefore, we performed a systematic review of relevant randomized controlled trials (RCTs) to evaluate the effect of EB on patient-important outcomes.MethodsWe systematically searched PubMed, the Cochrane Library, Web of Science, and Chinese databases since inception until March 30, 2020. Meta-analysis was carried out using “meta” package in R 3.4.3 software. A prespecified subgroup analysis was done according to the type of comparisons between groups, and the credibility of significant subgroup effects (P < 0.05) were accessed using a five-criteria list. A GRADE evidence profile was constructed to illustrate the certainty of evidence.ResultsOur meta-analysis, including 14 eligible trials with 1058 patients, showed that compared with routine treatment or health education as control groups, the mean difference (MD) in systolic blood pressure (SBP) of the EB groups was − 8.52 mmHg (95%CI:[− 10.65, − 6.40], P < 0.01) and diastolic blood pressure (DBP) was − 4.65 mmHg (95%CI: [− 6.55, − 2.74], P < 0.01). For blood pressure, the evidence was, however, of low certainty because of risk of bias and inconsistency, and for the outcomes of most interest to patients (cardiovascular morbidity and mortality directly), of very low certainty (measurement of surrogate only). Subgroup analysis showed there was no significant interaction effect between different type of comparisons (SBP P = 0.15; DBP P = 0.37), so it could be easily attributed to chance.ConclusionRegularly EB exercising may be helpful to control blood pressure, but the evidence is only low certainty for blood pressure and very low certainty for cardiovascular morbidity and mortality. Rigorously designed RCTs that carry out longer follow-up and address patient-important outcomes remain warranted.Trial registrationPROSPERO Registration number: CRD42018095854.
Highlights
Hypertension, a major risk factor of cardiovascular mortality, is a critical issue for public health
As a leading risk factor for fatal cardiovascular disease, hypertension is associated with increased risk of myocardial infarction (MI), stroke, peripheral artery disease (PAD), end-stage renal disease [5], and premature death [6], which greatly affects the quality of life and brings significant economic burdens to patients and their families [6]
Because diabetes and dyslipidemia are very common and Eight Brocades (EB) may impact on these conditions, as a secondary goal we examined the effect of EB on these outcomes
Summary
Search strategies We systematically searched the following databases since inception until March 30, 2020: PubMed, the Cochrane Library, Web of Science, Scopus, and Chinese databases including China National Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Database (CBM), VIP, and Wan Fang Database. Inclusion criteria (1) Type of study: We included randomized controlled trials (RCTs) reported in English or Chinese assessing EB for hypertension. The following studies were excluded: (a) Studies that lacked data for outcome evaluation even after contacting authors; (b) Besides antihypertensive drugs, Chinese decoctions, or health education, studies in which EB was combined with other kind of therapies like acupuncture, sitting; (c) Studies that examined a special population of hypertension, such as those with severe hypertension The two independent reviewers extracted the data from eligible studies and entered it into EpiData 3.2 (The EpiData Association, Odense, Denmark) including:(1) title, authors, publication year, study location and setting; (2) participants’ age, gender, duration of hypertension, diagnostic criteria, SBP, DBP, GLU, TG, TC, HDL-C and LDL-C at baseline and after treatment; (3) interventions, type of EB, controls, treatment duration, and risk of bias (ROB) assessment.
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